Anatomy of Scoliosis

To understand scoliosis, which causes the spine to curve to the left or right, you first need to
understand what a normal spine looks like. There are four regions in your spine:

• Cervical Spine: This is your neck, which begins at the base of your skull. It contains 7
small bones (vertebrae), which doctors label C1 to C7 (the 'C' means cervical). The
numbers 1 to 7 indicate the level of the vertebrae. C1 is closest to the skull, while C7 is
closest to the chest.
• Thoracic Spine: Your mid-back has 12 vertebrae that are labeled T1 to T12 (the 'T'
means thoracic). Vertebrae in your thoracic spine connect to your ribs, making this part
of your spine relatively stiff and stable. Your thoracic spine doesn't move as much as the
other regions of your spine, like the cervical spine.
• Lumbar Spine: In your low back, you have 5 vertebrae that are labeled L1 to L5 (the 'L'
means lumbar). These vertebrae are your largest and strongest vertebrae, responsible for
carrying a lot of your body's weight. The lumbar vertebrae are also your last "true"
vertebrae; down from this region, your vertebrae are fused. In fact, L5 may even be fused
with part of your sacrum.
• Sacrum and Coccyx: The sacrum has 5 vertebrae that usually fuse by adulthood to form
one bone; the coccyx—most commonly known as your tail bone—has 4 (but sometimes
5) fused vertebrae.

From behind, the normal spine appears straight. However, when viewed from the side, you'll see
that the spine has both inward and outward curves. These curves help our back carry our weight
and are also important for flexibility.

There are two types of curves in your spine: kyphosis and lordosis. You can see those from the
side view. Kyphosis means the spine curves inward; lordosis means the spine curves outward.
There are two kyphotic and two lordotic spinal curves in a normal spine. Your neck (cervical
spine) and low back (lumbar spine) have a lordotic curve. Your mid back (thoracic spine) and
pelvis (sacrum) have a kyphotic curve.
As you can probably tell from the basic curves of the spine, it's a complex structure. Your spine
is made up of many parts. Your spinal column, also called your vertebral column, has 24
individual bones-those are your vertebrae. In between the vertebrae, you have intervertebral discs
that act like pads or shock absorbers. Each disc is made up of a tire-like outer band (annulus
fibrosus) and a gel-like inner substance (nucleus pulposus).

Together, the vertebrae and the discs provide a protective tunnel (spinal canal) for the spinal cord
and spinal nerves. The spinal cord runs from the brain down through most of the spine. Nerves
branch off the spinal cord at interval and exit through openings called the foramen. From there,
nerves go to various parts of your body, helping you move and feel.

Besides the bones, discs, and nerves, your spine has muscles, ligaments, and blood vessels.
Muscles are strands of tissues that act as the source of power for movement. Ligaments are the
strong flexible bands of fibrous tissue that link the bones together. Tendons connect muscles to
bones and discs. Blood vessels provide nourishment. These parts work together to help you
move, and they also help stabilize your spine.

The basic Pathophysiology of Scoliosis

Scoliosis is an abnormal sideways curvature of the spine that is typically found in children and
adolescents. In most cases, scoliosis is painless. However, it can become gradually more severe
if left untreated, resulting in chronic back pain. In young children, severe cases can cause
deformities, impair development and be life-threatening.
In most cases, scoliosis is painless and develops gradually. It often worsens during growth spurts
in children and teens. Scoliosis patients who wear a back brace over an extended period of time
can usually prevent further curvature of the spine.

The cause of most cases of scoliosis cases is unknown (idiopathic). Suspected causes of scoliosis
include connective tissue disorders, muscle disorders, hormonal imbalance and abnormality of
the nervous system. Spinal cord and brainstem abnormalities may also contribute toscoliosis. The
condition can also be hereditary.

Physicians classify the causes of scoliosis curves into one of two categories:

• Nonstructural scoliosis. Also known as functional scoliosis, this involves a

spine that is structurally normal yet appears curved. This is a temporary
curve that changes, and is caused by an underlying condition such as
difference in leg length, muscle spasms or inflammatory conditions such as
appendicitis. Physicians usually treat this type ofscoliosis by addressing the
underlying condition. The term nonstructural scoliosis has also been used to
describe cases involving a side–to–side curvature.

• Structural scoliosis. This is a fixed curve that is treated individually according

to its cause. Some cases of structural scoliosis are the result of disease, such
as the inherited connective tissue disorder known as Marfan’s syndrome. In
other cases, the curve occurs on its own. Other causes include
neuromuscular diseases (such as cerebral palsy, poliomyelitis or muscular
dystrophy), birth defects, injury, infection, tumors, metabolic diseases,
rheumatic diseases or unknown factors. The term structuralscoliosis has also
been used to describe cases involving a twisting of the spine in three
dimensions rather than a sideways curvature.

Certain factors are known to increase the risk for scoliosis, as well as the risk that the disorder
will become more severe. These include:

• Sex. Girls ages 3 and older are more likely to have scoliosis than boys. In
contrast, boys are more likely to have the disorder than girls before age 3.

• Age. The younger a child is when scoliosis begins, the more severe the
condition is likely to become.

• Angle of the curve. The greater that angle of curve, the increased likelihood
that the condition will get worse.

• Location. Curves in the middle to lower spine are less likely to worsen than
those of the upper spine.

• Spinal problems at birth. Children who are born with scoliosis (congential
scoliosis) may experience rapid worsening of the curve.
Symptoms of Scoliosis

The list of signs and symptoms mentioned in various sources for Scoliosis includes the 7
symptoms listed below:

• Spinal curvature
• Sideways curvature of the spine
• Sideways body posture
• One shoulder raised higher than the other
• Clothes not hanging properly
• Local muscular aches
• Local ligament pain

Signs of scoliosis

Scoliosis may be suspected when one shoulder appears to be higher than the other, there is a
curvature in the spine, or the pelvis appears to be tilted. The treatment of scoliosis can involve
the use of a brace or surgery. Treatment is determined by the cause of the scoliosis, the size and
location of the curve, and the stage of bone growth of the patient.

Treatments and drugs

By Mayo Clinic staff
Scoliosis brace
Most children with scoliosis have mild curves and probably won't need treatment with a brace or
surgery. Children who have mild scoliosis may need checkups every four to six months to see if
there have been changes in the curvature of their spines.

While there are guidelines for mild, moderate and severe curves, the decision to begin treatment
is always made on an individual basis. Factors to be considered include:

• Sex. Girls have a much higher risk of progression than do boys.

• Severity of curve. Larger curves are more likely to worsen with time.
• Curve pattern. Double curves, also known as S-shaped curves, tend to worsen more
often than do C-shaped curves.
• Location of curve. Curves located in the center (thoracic) section of the spine worsen
more often than do curves in the upper or lower sections of the spine.
• Bone maturity. If a child's bones have stopped growing, the risk of curve progression is
low. That also means that braces have the most effect in children whose bones are still
growing.

Braces
If your child's bones are still growing and he or she has moderate scoliosis, your doctor may
recommend a brace. Wearing a brace won't cure scoliosis, or reverse the curve, but it usually
prevents further progression of the curve.

Most braces are worn day and night. A brace's effectiveness increases with the number of hours a
day it's worn. Children who wear braces can usually participate in most activities and have few
restrictions. If necessary, kids can take off the brace to participate in sports or other physical
activities.

Braces are discontinued after the bones stop growing. This typically occurs:

• About two years after girls begin to menstruate

• When boys need to shave daily

Braces are of two main types:

• Underarm or low-profile brace. This type of brace is made of modern plastic materials
and is contoured to conform to the body. Also called a thoracolumbosacral orthosis
(TLSO), this close-fitting brace is almost invisible under the clothes, as it fits under the
arms and around the rib cage, lower back and hips. Underarm braces are not helpful for
curves in the upper spine.
• Milwaukee brace. This full-torso brace has a neck ring with rests for the chin and for the
back of the head. The brace has a flat bar in the front and two flat bars in the back.
Because they are more cumbersome, Milwaukee braces usually are used only in
situations where an underarm brace won't help.

Surgery
Severe scoliosis typically progresses with time, so your doctor might suggest scoliosis surgery —
called spinal fusion — to reduce the severity of the spinal curve and to prevent it from getting
worse.

Spinal fusion surgery connects two or more of the bones in your spine (vertebrae) together with
new bone. Surgeons may use metal rods, hooks, screws or wires to hold that part of the spine
straight and still while the bone heals. The process is similar to what occurs when a broken bone
heals.

Complications may include bleeding, infection, pain, nerve damage or failure of the bone to heal.
Rarely, another surgery is needed if the first one fails to correct the problem.

Nursing management of the adolescent with

idiopathic scoliosis.
Brosnan H.

Source

Rush University, College of Nursing, Chicago, Illinois 60612.

Abstract

Management of the adolescent idiopathic scoliosis patient has many intricate considerations.
Whether the patient is braced or surgery is recommended, there is a lot of teaching, assessing,
and compassion when dealing with adolescents whose biggest concern is being like their peers. It
is important to allow as much independence in decision making as possible, whether it be about
bracing or surgical intervention, as long as they clearly understand the consequences. Newer,
better surgical instruments, anesthesia, nursing care, and postoperative mobility all have changed
the management of the operative scoliosis patient significantly. Nursing assessment of
neurologic, respiratory, function, emotional, and developmental needs of the adolescent patient,
however, have not changed. If we, as nurses, understand the rationale for assessments,
treatments, and restrictions, we can teach our patients and their families.